Craig Spencer's Fight With Ebola and Political Expedience

Jenni Laidman

February 25, 2015

In a strange way, Craig Spencer, MD, MPH, almost felt relieved the morning he realized he had contracted Ebola, he writes in the February 25 issue of the New England Journal of Medicine. After carefully monitoring his health, twice daily checking his temperature, the sudden sign of fever meant he could let go of his fear.

Dr Spencer, who had worked with Ebola patients in Guéckédou, Guinea, until October 12, was New York City's first Ebola patient. Now recovered, he has written a perspective article that goes beyond just a personal narrative: In it he sharply criticizes the misinformed panic his infection engendered.

"After my diagnosis, the media and politicians could have educated the public about Ebola. Instead, they spent hours retracing my steps through New York and debating whether Ebola can be transmitted through a bowling ball."

The panic led to the establishment of a 21-day waiting period for healthcare workers returning from battling Ebola, a waiting period he calls a mistake.

It was not that Dr Spencer did not understand the fear Ebola engenders, he writes. "As a clinician and epidemiologist, I've worked in places just miles from active conflict and managed to grow used to the sight of soldiers and the sound of gunfire. But this microscopic virus, an invisible enemy, made me uneasy." He writes of waking in the middle of the night in Guinea, sweating, his heart racing, worried that the thermometer reading of 97.7° F only meant his thermometer was broken.

"Though I understood the connection between psychological stress and physical pain, I'd never experienced it like this," he writes.

Still, his first hour of caring for patients each day, perspiring in his layers of protective gear, "washed away my fear and made me feel new again.

"I'd never felt so deeply that my decisions could have a measurable impact on other people's lives." Still, he returned home depressed for the first time in his life, he writes. And there was the fear. "Twice a day, I held my breath in fear when I put a thermometer in my mouth. I did all this worrying well before I ever had a fever or showed any symptoms of Ebola."

During his illness, he lost 20 lbs, was feverish for two weeks, and struggled to the bathroom as many as a dozen times daily. His liver failed, he notes, just as his fiancée was being quarantined in their apartment, and he was vilified in the media with false reports claiming he had gone about in the city while symptomatic. "People feared riding the subway or going bowling because of me. The whole country soon knew where I like to walk, eat, and unwind."

Politicians, with an eye toward upcoming elections, gave into the panic, he writes, "Instead of supporting a sound, science-based public health response." The governors of New York and New Jersey, ignoring guidelines from the Centers for Disease Control and Prevention, and later followed by others, enacted strict home-quarantine rules that failed to consider the unintended consequence of people hiding information to avoid quarantine. "At times of threat to our public health, we need one pragmatic response, not 50 viewpoints that shift with the proximity of the next election," Dr Spencer writes.

"When we look back on this epidemic, I hope we'll recognize that fear caused our initial hesitance to respond — and caused us to respond poorly when we finally did," he concludes. I know how real the fear of Ebola is, but we need to overcome it. We all lose when we allow irrational fear, fueled in part by prime-time ratings and political expediency, to supersede pragmatic public health preparedness."

N Engl J Med. February 25, 2015.


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